A large mass in the pericardial space

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A large mass in the pericardial space

Adem Dereci

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, Alexander Hirsch

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, Mohamed Attrach

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, and Eric A. Dubois

1

*

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Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, ‘s-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands;2

Department of Cardiology and Radiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, ‘s-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands; and3Department of Radiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, ‘s-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands

Received 18 October 2017; revised 15 January 2018; accepted 23 January 2018; online publish-ahead-of-print 9 February 2018

Case description

A 73-year-old woman with a history of hypertension was referred with pericardial effusion and suspected cardiac tamponade. She reported progressive dyspnoea and pain in the back and between the scapulae for several weeks. Except a dry cough and fever, she reported no other symptoms. Physical examination revealed a nor-mal blood pressure without left–right difference. She was tachycardic and showed jugular venous distension. Oxygen saturation was 94% while on 2 L/min oxygen supply. Remaining physical examination was unremarkable. Electrocardiography showed atrial tachycardia at

125/min without signs of ischaemia. Laboratory tests identified ele-vated C-reactive protein (216 mg/L), eleele-vated high-sensitive troponin T (471 ng/L), and low lactate levels. Echocardiography showed cir-cumferential pericardial effusion up to 2.5 cm and a large mass in the pericardial space near anterior side of the left ventricle. Computed tomography showed no aortic dissection but revealed a large parti-ally calcified mass in the pericardium (Figure1A). Cardiovascular mag-netic resonance imaging showed an 8 7 6 cm mass in the pericardial space near the anterior interventricular groove suggestive of a giant coronary artery aneurysm (gCAA) almost completely filled with thrombus. No myocardial infarction was seen on late gadolinium

Figure 1Computed tomography (A) and coronary angiogram (B) showing a large partially calcified mass in the pericardium supplied by a coronary artery (A).

* Corresponding author. Tel:þ31107040704, Fax: þ31107035513, Email:e.dubois@erasmusmc.nl. This article was peer reviewed by reviewers when submitted to ‘Europace’. Accepted to EHJ Case Reports.

VC_{The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.}

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

European Heart Journal - Case Reports (2018) 2, 1–2

IMAGES IN CARDIOLOGY

doi:10.1093/ehjcr/yty011

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enhancement MRI images (Figure 2). Coronary angiography (CA) revealed swirling of contrast within the gCAA originating from the first diagonal coronary artery (Figure1B). However on both cine mag-netic resonance imaging and CA, no clear drainage of the gCAA could be determined. gCAA’s usually arise from the right coronary artery (seeSupplementary materialonline, videos).1They are caused by vasculitides, congenital heart disease (CHD), or coronary artery disease (CAD). Our patient showed no obstructive CAD, vasculiti-des, or CHD. Although percutaneous closure may be considered in patients with gCAA’s, surgical correction is the preferred therapy.2 Our patient refused surgical correction and recovered well after per-cutaneous closure of the first diagonal artery by a vascular plug and drainage of pericardial effusion. She was treated with aspirin for 6 months for endothelialization of the vascular plug.

Supplementary material

Supplementary materialis available at European Heart Journal - Case Reports online.

Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.

Conflict of interest: none declared.

References

1. Keyser A, Hilker MK, Husser O, Diez C, Schmid C. Giant coronary aneurysms exceeding 5 cm in size. Interact Cardiovasc Thorac Surg 2012;15:33–36.

2. Daoud AS, Pankin D, Tulgan H, Florentin A. Aneurysms of the coronary artery. Report of ten cases and review of literature. Am J Cardiol 1963;11:228–237.

Figure 2Cardiovascular magnetic resonance imaging of the giant coronary aneurysm: short axis steady state free procession (A), first pass perfu-sion (B), and late gadolinium enhancement (C) images.

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